D443 Health Assessment - Set 3 - Part 3

Correct Answer: Conductive hearing loss

Cerumen impaction physically blocks the transmission of sound waves through the external canal to the middle ear, producing a conductive hearing loss. In the Weber test, sound lateralizes toward the affected ear in conductive loss because the blockage prevents ambient noise from masking the tone and the ear becomes more attuned to bone-conducted sound. Sensorineural loss and presbycusis arise from cochlear or nerve damage and cause the Weber to lateralize to the better ear, and central processing disorders involve the brain rather than sound conduction. The mechanical obstruction here defines a conductive deficit.

Correct Answer: Up and back

In adults and children over about three years of age, the external auditory canal is directed forward and downward, so pulling the auricle up and back straightens the S-shaped canal and aligns it for clear visualization of the tympanic membrane. In infants and young children the canal points upward, so the auricle is pulled down and back instead. Pulling the ear forward or pressing it against the head does not straighten the canal and would obstruct the view. Correct technique also reduces discomfort during insertion of the speculum.

Correct Answer: In the anteroinferior quadrant, around the 5 o'clock position

The cone of light is a triangular reflection produced when the otoscope light strikes the intact, properly angled tympanic membrane. In the right ear it normally appears in the anteroinferior quadrant at roughly the 5 o'clock position, and in the left ear at roughly the 7 o'clock position. Its presence and position confirm a normal, non-bulging, non-retracted membrane. A displaced, distorted, or absent cone of light suggests fluid, infection, or pressure changes behind the drum. The umbo marks the center attachment of the malleus, not the location of the light reflex.

Correct Answer: Kiesselbach plexus

Kiesselbach plexus (also called Little's area) is a convergence of several arteries on the anterior nasal septum, and its superficial, exposed location makes it the source of roughly ninety percent of nosebleeds. First aid focuses on this area by having the patient lean forward and pinch the soft anterior nose. The turbinates warm and humidify air but are not the usual bleeding site, the cribriform plate transmits the olfactory nerve, and posterior bleeds from the sphenopalatine artery are less common but more severe. Anterior epistaxis overwhelmingly arises from Kiesselbach plexus.

Correct Answer: The sinus is filled with fluid or pus

A healthy sinus is filled with air, which allows light to pass through and produce a dull red glow when transilluminated. When a sinus is filled with fluid, pus, or thickened mucosa, as in sinusitis, the light is blocked and transillumination is diminished or absent on the affected side. This asymmetry supports a diagnosis of sinus infection or congestion. A deviated septum affects airflow rather than light transmission through the sinus, and while sinus size varies, a fluid-filled sinus rather than an absent one best explains loss of glow with concurrent facial pressure.

Correct Answer: Frontal and maxillary sinuses

Only the frontal and maxillary sinuses are superficial enough to be palpated and transilluminated during a physical examination. The frontal sinuses are assessed by pressing up on the bony ridges under the eyebrows, and the maxillary sinuses by pressing on the cheeks below the eyes. Tenderness over these areas suggests sinus inflammation. The ethmoid and sphenoid sinuses lie deep within the skull behind the nose and eyes and cannot be directly palpated. The mastoid is part of the temporal bone, not a paranasal sinus, so the frontal and maxillary sinuses are the accessible pair.

Correct Answer: Allergic rhinitis

In allergic rhinitis the nasal mucosa and turbinates classically appear pale, boggy, and bluish-gray or swollen, accompanied by clear watery discharge, sneezing, and itching. This contrasts with acute infectious rhinitis, in which the mucosa is red and swollen with purulent yellow-green drainage. A nasal foreign body typically produces unilateral, foul-smelling, sometimes bloody discharge, and epistaxis presents with active bleeding rather than pale boggy turbinates. The combination of allergic symptoms and pale, edematous mucosa is characteristic of an allergic process.

Correct Answer: Grade 4+

Tonsils are graded on a scale from 1+ to 4+ based on how far they extend into the pharyngeal space. Grade 1+ tonsils are visible within the tonsillar pillars, 2+ extend to the pillars, 3+ extend beyond the pillars toward the uvula, and 4+ tonsils meet or touch at the midline, sometimes called kissing tonsils. Tonsils that touch each other therefore represent grade 4+, which can threaten the airway. Grade 0 indicates surgically absent or non-visible tonsils. Documenting the correct grade communicates the degree of obstruction to the care team.

Correct Answer: Leukoplakia, a potentially precancerous lesion

Leukoplakia is a white, thickened, firmly adherent patch of the oral mucosa that cannot be rubbed or scraped off. It is strongly associated with chronic irritation from tobacco and alcohol and is considered a premalignant lesion that warrants biopsy to rule out squamous cell carcinoma, especially in an older patient with tobacco exposure. Oral candidiasis produces white plaques that do scrape off, revealing a red base, and aphthous ulcers are painful shallow erosions rather than adherent white plaques. A painless, non-removable white patch in a smoker must be evaluated for malignancy.

Correct Answer: Oral candidiasis (thrush)

Oral candidiasis, or thrush, is a fungal infection producing creamy white, curd-like plaques on the tongue and buccal mucosa that can be scraped off to reveal an erythematous, sometimes bleeding base. It is common in immunocompromised patients, infants, and people using inhaled corticosteroids or broad-spectrum antibiotics. The ability to wipe the plaque off distinguishes it from leukoplakia, which is firmly adherent and non-removable. Geographic tongue produces migrating map-like patches, and carcinoma presents as a persistent ulcer or mass. The removable white plaques over a raw red base are diagnostic of thrush and are treated with antifungals.